Impact of anterior skull base fracture on lateralized olfactory function.

BACKGROUND: Data on the impact of anterior skull base fractures (aSBF) on lateralized olfactory function are missing. The goal of the study was to investigate olfactory function in patients with traumatic brain injury (TBI) due to aSBF separately for each side and assess the frequency of lateralized smell impairment. METHODS: Retrospective, single center study of olfactory function in 93 patients with aSBF. Olfactory function was assessed by means of the Sniffin' Sticks test battery for each side of the nose, separately. TBI severity was graded according to the Glasgow Coma Scale. Average time interval between olfactory test and trauma was 6.5 years. General olfactory function was defined as the best side out of both nostrils. RESULTS: A total of 50 patients had unilateral and 43 patients bilateral aSBF. The grade of TBI was inversely correlated with olfactory function. General olfactory function was significantly worse in patients with bilateral aSBF compared to patients with unilateral aSBF. Clinically significant side by side differences in olfactory function were found in 18 and 30% respectively for unilateral and bilateral aSBF. Grade of TBI had no significant impact on side differences. Among patients with unilateral aSBF olfactory function was not significantly different between the fractured and the non-fractured side. CONCLUSION: The severity of TBI and bilateral more than unilateral aSBF results in more impaired olfactory function. Lateralized olfactory deficits were not more frequent in any group, regardless of the fracture type and side.

Structural Plasticity of the Primary and Secondary Olfactory cortices: Increased Gray Matter Volume Following Surgical Treatment for Chronic Rhinosinusitis.

Functional plasticity of the adult brain is well established. Recently, the structural counterpart to such plasticity has been suggested by neuroimaging studies showing experience-dependent differences in gray matter (GM) volumes. Within the primary and secondary olfactory cortices, reduced GM volumes have been demonstrated in patients with olfactory loss. However, these cross-sectional studies do not provide causal evidence for GM volume change, and thereby structural plasticity. Disorders of the peripheral olfactory system, such as chronic rhinosinusitis (CRS), provide an ideal model to study GM structural plasticity, given that patients may experience long periods of olfactory impairment, followed by near complete recovery with treatment. We therefore performed a prospective longitudinal study in patients undergoing surgical treatment for CRS. We used voxel-based morphometry (VBM) to investigate GM volume change in 12 patients (M:F = 7:5; 47.2 ±â€¯14.9 years), 3 months post-op. There was a significant improvement in olfactory function according to birhinal psychophysical testing. We performed a voxel-wise region of interest analysis, with significance corrected for number of regions (p < 0.0036corr). We found significantly increased post-operative GM volumes within the primary (left piriform cortex, right amygdala) and secondary (right orbitofrontal cortex, caudate nucleus, hippocampal-parahippocampal complex and bilateral temporal poles) olfactory networks, and decreased GM volumes within the secondary network only (left caudate nucleus and temporal pole, bilateral hippocampal-parahippocampal complex). As a control measure, we assessed GM change within V1, S1 and A1, where there were no suprathreshold voxels. To our knowledge, this is the first study to demonstrate GM structural plasticity within the primary and secondary olfactory cortices, following restoration of olfaction.

Decreased electrogustometric taste sensitivity in patients with acquired olfactory dysfunction.

BACKGROUND: Cross-modal chemosensory dysfunction between olfaction and gustation is not well known. METHODOLOGY: 180 participants were classified into three groups (60 with olfactory dysfunction, 60 with gustatory dysfunction and 60 healthy controls without chemosensory dysfunction). Olfactory functions were obtained with Sniffin Sticks; gustatory function was measured by suprathreshold gustatory stimuli (taste sprays) and a quasi-threshold measure of taste function (taste strips) for five taste qualities (sweet, salty, sour, bitter and umami). Electric taste threshold was measured using electrogustometry (EGM). In addition, group differences in dietary behaviors were investigated with a specifically designed questionnaire. RESULTS: Patients with olfactory dysfunction had increased electric taste thresholds and decreased scores for the umami taste strip test as compared to healthy controls. Overall there was no major difference between patients with chemosensory dysfunction and healthy controls regarding dietary behaviors, although some patients certainly exhibited dietary problems. Importantly, patients with taste loss, but not patients with smell loss, exhibited a higher degree of depression than controls. CONCLUSION: Patients with olfactory dysfunction showed decreased taste sensitivity which suggested an interaction between the chemical senses taste, trigeminal function, and olfaction. This provides the basis for including both smell and taste psychophysical assessment in clinical practices. In addition, patients with taste loss appeared to suffer most from chemosensory dysfunction.

Olfaction and sinonasal symptoms in patients with CRSwNP and AERD and without AERD: a cross-sectional and longitudinal study.

Oral aspirin challenge (OAC) reveals aspirin-exacerbated respiratory disease (AERD) in approximately 50% of unselected patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Smell loss is one factor that predicts the outcome of OAC. The present study aims to unveil differences in olfactory function between patients with CRSwNP with and without AERD by means of a validated reliable test for odor threshold, discrimination and identification. Additionally, Beck Depression Inventory (BDI) and Sinonasal Outcome Test 22 (SNOT 22) were applied. 31 patients were tested before and 7 months after OAC and aspirin desensitization in case of diagnosed AERD. AERD was diagnosed in 16 and excluded in 15 patients. Patients with AERD demonstrated significantly more olfactory loss, but no difference in BDI or SNOT 22 at baseline. Olfaction of the groups equalized at follow-up. Sinonasal complaints decreased significantly in patients with AERD, but not in the group without AERD. Olfactory loss is a valuable marker for AERD, but due to the variance of olfactory test results prediction of AERD by exclusively any of the applied olfactory tests appears unreliable.

Changes of olfactory abilities in relation to age: odor identification in more than 1400 people aged 4 to 80 years.

The currently presented large dataset (n = 1,422) consists of results that have been assembled over the last 8 years at science fairs using the 16-item odor identification part of the "Sniffin' Sticks". In this context, the focus was on olfactory function in children; in addition before testing, we asked participants to rate their olfactory abilities and the patency of the nasal airways. We reinvestigated some simple questions, e.g., differences in olfactory odor identification abilities in relation to age, sex, self-ratings of olfactory function and nasal patency. Three major results evolved: first, consistent with previously published reports, we found that identification scores of the youngest and the oldest participants were lower than the scores obtained by people aged 20-60. Second, we observed an age-related increase in the olfactory abilities of children. Moreover, the self-assessed olfactory abilities were related to actual performance in the smell test, but only in adults, and self-assessed nasal patency was not related to the "Sniffin' Sticks" identification score.

Increasing olfactory bulb volume due to treatment of chronic rhinosinusitis--a longitudinal study.

Differentiation of progenitor cells into neurons in the olfactory bulb depends on olfactory stimulation that can lead to an increase in olfactory bulb volume. In this study, we investigated whether the human olfactory bulb volume increases with increasing olfactory function due to treatment of chronic rhinosinusitis. Nineteen patients with chronic rhinosinusitis were investigated before and after treatment. For comparison, additional measurements were performed in 18 healthy volunteers. Volumetric measurements of the olfactory bulb were based on planimetric manual contouring of magnetic resonance scans. Olfactory function was evaluated separately for each nostril using tests for odour threshold, odour discrimination and odour identification. Measurements were performed on two occasions, 3 months apart. In healthy controls, the olfactory bulb volume did not change significantly between the two measurements. In contrast, the olfactory bulb volume in patients increased significantly from the initial 64.5 +/- 3.2 to 70.0 +/- 3.5 mm(3) on the left side (P = 0.02) and from 60.9 +/- 3.5 to 72.4 +/- 2.8 mm(3) on the right side (P < 0.001). The increase in olfactory bulb volume correlated significantly with an increase in odour thresholds (r = 0.60, P = 0.006, left side; r = 0.49, P = 0.03, right side), but not with changes in odour discrimination or odour identification. Results of this study support the idea that stimulation of olfactory receptor neurons impacts on the cell death in the olfactory bulb, not only in rodents but also in humans. To our knowledge, this is the first longitudinal study that describes an enlargement of the human olfactory bulb due to improvement of peripheral olfactory function.

Gustatory testing for clinicians.

Gustatory testing for clinicians. By contrast with the evaluation of olfactory function, which has been standardised for almost two decades, the clinical assessment of gustatory function with psychophysical and objective testing is still in its infancy. This overview will attempt to summarise the knowledge that is important for clinicians in the awareness that progress in the field is ongoing. We focus on psychophysical testing but also discuss some recent achievements in the area of objective taste testing. There are now validated tests available for simple quick scans of gustatory function but debate continues about the extent to which such tests can be used for medico-legal purposes. In addition to emerging measures such as gustatory event-related potentials and functional imaging, routine objective gustatory testing will be needed in the future.

Sense of smell in workers exposed to agricultural odours.

AIM: To investigate the effect of occupational exposure to agricultural odours on sense of smell. METHODS: Olfaction was investigated in 60 employees of dairy and pig-breeding farms and compared to 60 non-farm controls living in the same rural area. Both groups were matched for age, sex and smoking habits. All participants underwent standardized, validated tests for olfactory function and were tested before and after the first day of a working cycle. In addition, farm subjects were also tested in the evening of Day 5 of this period. RESULTS: There was no difference in overall olfactory function between the two groups. Olfactory function was not related to duration of exposure to the odorous environment. CONCLUSION: These results suggest that occupational exposure to strong agricultural odours has no major impact on the sense of smell.

[Multiple endocrine neoplasia type 1]. / Multiple endokrine Neoplasie Typ 1.

Owing to the growing use of ultrasound in the head and neck and to technical progress, the number of tumours diagnosed in the thyroid region is increasing. The rare differential diagnosis of multiple endocrine neoplasm type 1 in a case with a unilateral intrathyroidal lump and two lumps located dorsal to the contralateral thyroid is discussed.

Sildenafil affects olfactory function.

PURPOSE: Sildenafil is the first member of a new class of oral drugs effective for erectile dysfunction. However, approximately 20% of patients complain about nasal congestion after sildenafil administration. MATERIALS AND METHODS: Because nasal airflow and olfaction are closely linked, the sense of smell was evaluated in 20 young, healthy volunteers after the administration of 50 and 100 mg sildenafil, and placebo in a double-blinded, crossover study. Olfactory function was evaluated using a standardized and validated test (Sniffin' Sticks). To investigate a possible impact of G-protein beta3 subunit C825T polymorphism on the effect of sildenafil on olfaction the genotype of all subjects was determined. RESULTS: The effect of sildenafil on olfaction was only present at a dose of 100 mg but not at a dose of 50 mg sildenafil. The genotypes TT, CC and TC of the G-protein beta3 C825T polymorphism had no impact on the change in olfactory function. CONCLUSIONS: Higher sildenafil doses may produce decreased olfactory sensitivity.

[Chronic eustachian tube dysfunction and its sequelae in adult patients with cleft lip and palate]. / Chronische Tubendysfunktion und ihre Folgeerkrankungen bei Erwachsenen mit einseitiger Lippen-Kiefer-Gaumen-Spalte.

BACKGROUND: While almost all children with cleft palate develop eustachian tube dysfunction, this tends to normalize with age although it remains impaired in a number of patients. METHODS: Eustachian tube function was evaluated by tympanometry in 40 patients with an average age of 19.9 years. The number of patients with chronic otitis media, a sequelae of chronic eustachian tube dysfunction, was determined microscopically and from the patient's history. Hearing was assessed by pure tone RESULTS: Eustachian tube dysfunction was found bilaterally in 25% of the patients and unilaterally in 6%, while chronic otitis media was found in 32.5% and 12.5%, respectively. The hearing level did not differ between the side of the cleft and the opposite side (P=0.562). CONCLUSION: Nearly a third of the adult patients still suffered from eustachian tube dysfunction. Pathological tympanograms and chronic otitis media usually occurred bilaterally. A relationship between the side of the cleft and the side on which the eustachian tube dysfunction or its sequelae occurred was not apparent. The main reason seems to be the continuing bilateral muscular insufficiency in opening the eustachian tube.

Rapid Rhino: A new pneumatic nasal tamponade for posterior epistaxis.

OBJECTIVES: Some of these measures to control posterior epistaxis cause loss of nasal respiration and put the patient on those related risks. STUDY DESIGN AND METHODS: The efficiency of a new pneumatic nasal tamponade (Rapid Rhino) was compared with a choanal balloon tamponade that has been used in our department for years in a prospective randomized study in patients with posterior epistaxis. The new pneumatic tamponade was used on the affected side only and nasal ventilation of the contralateral side was possible. RESULTS: Because of the successful use of the new pneumatic tamponade in most of the patients, epistaxis could be controlled without bilateral obstruction of nasal respiration. The use of the new pneumatic tamponade was evaluated to be less painful by the patients than choanal balloon tamponade. CONCLUSION: In an adapted therapeutic regime, the new pneumatic tamponade seems to have its place before using bilateral nasal respiration obstructing measures.

[Otological findings in adults with isolated cleft palate or cleft lip, jaw, and palate]. / Otologische Befunde von Erwachsenen mit isolierter Gaumenspalte oder Lippen-Kiefer-Gaumen-Spalte.

BACKGROUND: Children with cleft palate often develop middle ear ventilation disorders due to chronic Eustachian tube dysfunction. This may lead to hearing loss. The insertion of ventilation tubes is a widely accepted measure to avoid sequelae of middle ear ventilation disorders and hearing loss. On the other hand, long-term therapy with ventilation tubes may inflict iatrogenic complications. The objective of the study was the evaluation of otoscopic and audiometric long-term findings in adult cleft patients who had been treated with ventilation tubes since childhood when chronic otitis media with effusion had been observed. PATIENTS AND METHODS: Ninety-two cleft palate patients had been followed up otoscopically and audiometrically for years. The average age was 19.3 years (minimum: 14, maximum: 39 years) at the time the last status was taken. RESULTS: Otoscopy revealed a perforation of the tympanic membrane in 3.8% of the 184 ears. 12% of the patients developed cholesteatoma, however three quarters of these occurred after age 11. 86.4% of the 92 patients had normal hearing in pure tone audiometry. CONCLUSION: Compared with adult cleft patients who did not receive ventilation tubes, our patients had a similar low incidence of eardrum perforations but a higher incidence of cholesteatomas while hearing loss occurred less often. Whether the higher incidence of cholesteatomas is caused iatrogenically or due to a longer follow-up period remains unclear. Whether the use of long-lasting ventilation tubes affects the incidence of cholesteatomas must be proved in further studies.